BNF for Children 2011-2012

314 5.3.1 HIV infection BNFC 2011–20125 InfectionsSide-effects see notes above; also peripheral neuropathy(switch to another antiretroviral if peripheralneuropathy develops), abnormal dreams, cognitivedysfunction, drowsiness, depression, pruritus; lesscommonly anxiety, gynaecomastiaLicensed use capsules not licensed for use in childrenunder 3 monthsIndication and doseHIV infection in combination with other antiretroviraldrugs when no suitable alternativeavailable and when prescribed for shortestperiod possible. By mouthChild 1 month–18 yearsBody-weight under 30 kg 1 mg/kg twice daily,preferably at least 1 hour before foodBody-weight 30–60 kg 30 mg twice daily, preferablyat least 1 hour before foodBody-weight over 60 kg 40 mg twice daily, preferablyat least 1 hour before foodZerit c (Bristol-Myers Squibb) ACapsules, stavudine 20 mg (brown), net price 56-cappack = £139.46; 30 mg (light orange/dark orange), 56-cap pack = £146.25; 40 mg (dark orange), 56-cap pack= £150.66 (all hosp. only)Oral solution, cherry-flavoured, stavudine for reconstitutionwith water, 1 mg/mL, net price 200 mL =£22.94TENOFOVIR DISOPROXILCautions see notes above; also test renal function andserum phosphate before treatment, then every 4weeks (more frequently if at increased risk of renalimpairment) for 1 year and then every 3 months,interrupt treatment if renal function deteriorates orserum phosphate decreases; concomitant or recentuse of nephrotoxic drugs; on discontinuation, monitorpatients with hepatitis B (risk of exacerbation ofhepatitis); interactions: Appendix 1 (tenofovir)Hepatic impairment see notes above and CautionsaboveRenal impairment increase dose interval if estimatedglomerular filtration rate less than 50 mL/minute/1.73 m 2 ; avoid Atripla c if estimated glomerularfiltration rate less than 50 mL/minute/1.73 m 2 ; avoidTruvada c if estimated glomerular filtration rate lessthan 30 mL/minute/1.73 m 2Pregnancy manufacturer advises use only if potentialbenefit outweighs risk—no information availableBreast-feeding see p. 310Side-effects see notes above; also hypophosphataemia;rarely renal failure, proximal renal tubulopathy,nephrogenic diabetes insipidus; also reported reducedbone densityLicensed use not licensed for use in childrenIndication and doseHIV infection in combination with other antiretroviraldrugsFor dose, consult Guidelines (see notes above)Viread c (Gilead) TATablets, f/c, blue, tenofovir disoproxil (as fumarate)245 mg, net price 30-tab pack = £255.00. Label: 21,counselling, administrationCounselling Children with swallowing difficulties may dispersetablet in half a glass of water, orange juice, or grapejuice (but bitter taste)With emtricitabineFor cautions, contra-indications, and side-effectssee under individual drugsTruvada c (Gilead) ATablets, blue, f/c, tenofovir disoproxil (as fumarate)245 mg, emtricitabine 200 mg, net price 30-tab pack =£418.50. Label: 21, Counselling, administrationChildren with swallowing difficulties may disperse tablet inhalf a glass of water, orange juice, or grape juice (but bittertaste)With efavirenz and emtricitabineFor cautions, contra-indications, and side-effectssee under individual drugsAtripla c (Gilead) ATablets, pink, f/c, efavirenz 600 mg, emtricitabine200 mg, tenofovir disoproxil (as fumarate) 245 mg, netprice 30-tab pack = £626.90. Label: 23, 25ZIDOVUDINE(Azidothymidine, AZT)Note The abbreviation AZT which is sometimes used forzidovudine has also been used for another drugCautions see notes above; also haematological toxicityparticularly with high dose and advanced disease—monitorfull blood count after 4 weeks oftreatment, then every 3 months; vitamin B 12 deficiency(increased risk of neutropenia); if anaemia ormyelosuppression occur, reduce dose or interrupttreatment according to product literature, or considerother treatment; interactions: Appendix 1 (zidovudine)Contra-indications abnormally low neutrophil countor haemoglobin concentration (consult product literature);neonates with hyperbilirubinaemia requiringtreatment other than phototherapy, or with raisedtransaminase (consult product literature); acute porphyria(section 9.8.2)Hepatic impairment see notes above; also accumulationmay occurRenal impairment reduce dose if estimated glomerularfiltration rate less than 10 mL/minute/1.73 m 2 ;consult product literaturePregnancy limited information available; manufactureradvises use only if clearly indicated; see alsop. 310Breast-feeding see p. 310Side-effects see notes above; also anaemia (mayrequire transfusion), taste disturbance, chest pain,influenza-like symptoms, paraesthesia, neuropathy,convulsions, dizziness, drowsiness, anxiety, depression,loss of mental acuity, myopathy, gynaecomastia,urinary frequency, sweating, pruritus, pigmentation ofnails, skin and oral mucosa